Although
nobodyís perfect, a growing number of us seem to be searching for a
way to achieve perfection, judging by the increasing demand for
cosmetic procedures. In fact, the total number of surgical and
nonsurgical cosmetic procedures performed in the United States by
plastic surgeons has nearly doubled since 2000. Hereís a glimpse at
what is popular in the greater Milwaukee area.

Tummy Tuck: The
tummy tuck or abdominoplasty is among the top surgeries being
performed by Dr. Philip L. Sonderman of Greater Milwaukee Plastic
Surgeons in Brookfield. "This is a procedure that flattens the
abdomen by removing extra fat and skin and tightening the muscles in
the abdominal wall. It can now be done as an outpatient procedure with
the use of a new long-acting local anesthetic, which cuts recovery
time way down," Sonderman explains.

Breast
Augmentation: Along with the tummy tuck, breast augmentation is in
high demand, Sonderman says. "This is especially true now that
there is a much improved silicone gel implant that holds its shape and
is more natural looking and natural feeling," he says. "Not
only that, but the implants have a much lower chance of capsular
contracture or leakage, which was the problem in the past."

Body Contouring:
Liposuction, which surgically removes fat cells from the body, has
been around for some time. Now, nonsurgical fat reduction using
ultrasound and radio frequency is quickly taking over. "This
nonsurgical, noninvasive body contouring and skin-tightening treatment
melts fat cells so the body reabsorbs them," says Dr. Andrew
Campbell of Quintessa Medical Spa in Mequon. "A patient usually
has several treatments over a period of weeks, but unlike liposuction,
there are minimal restrictions after these treatments."

Blepharoplasty
(eyelid surgery): "Blepharoplasty, otherwise known as a Ďlid-lift,í
of the upper and sometimes lower eyelids is the most commonly
performed eyelid surgery," says Dr. Bruce M. Massaro, a
board-certified ophthalmic plastic surgeon. "Cosmetic eyelid
surgeries reshape the lids, correct sagging, bagging and drooping
eyelid tissues that make people look tired and older. Surgeries
involve the removal, support, contouring and redirection of these
delicate tissues to create a natural, rested, more youthful
appearance," he says, noting that the eyelid incisions can easily
be hidden in the natural lid lines.

Forehead/Brow
Lift: "Some patients with heavy-looking eyelids who undergo
blepharoplasty also may require eyebrow or forehead lifting because
the upper face tends to slide downward with age, affecting the look of
the eyes," Massaro says. "The forehead/brow lift most often
involves incisions hidden behind the hairline of the scalp."

Ptosis Repair:
Additionally, some patients with "heavy eyelids" also
require repair of the internal eyelid lifting muscle known as ptosis
repair, which is done along with the blepharoplasty. Massaro notes
that the number of blepharoplasty surgeries he has performed has
increased during the last decade. "Typical patients are in their
40s and 50s, and while women outnumber men, the number of men seeking
surgery continues to increase," he says.

Laser Skin
Resurfacing: "We are doing an increasing number of laser
treatments," Campbell says. "The treatments are tailored to
the patient and we often use a combination of lasers to treat dark
spots, improve the texture and surface irregularities of the skin, and
erase lines and creases, for example. It is highly customized and
extremely effective," he adds.

Mini Face-Lift:
A mini face-lift can remove years from your face and improve your
outlook ó in just one afternoon. "The mini lift is not as
invasive or costly as a full face-lift, but it can be very
effective," Sonderman says, noting that younger patients in their
40s are requesting these procedures. "The mini lift provides many
of the same benefits of a full face-lift, but shorter incisions are
made; therefore thereís less scarring and a quicker recovery,"
he says.

Injectable
Fillers: Botox and other injectable fillers are in demand because of
their ability to improve and relax frown lines and reduce facial
wrinkles and imperfections. "Voluma, a brand new filler, has been
approved by the FDA and specifically designed to restore volume to the
midface. This filler has a much longer life, lasting up to two
years," Campbell says, stressing that it is important for the
person performing the procedure to understand the facial anatomy to
get the best results.

Rhinoplasty:
Commonly called a "nose job," rhinoplasty can reshape the
nose and is one of the most common of all plastic surgery procedures.
"It can reduce or increase the size of the nose, change the shape
of the tip or the bridge, narrow the span of the nostrils, or change
the angle," according to Sonderman. It also may be done to
correct a birth defect or injury. "It is important to have
realistic expectations about this surgery and all plastic surgery and
procedures," he adds.

What is
the Shelf life of your cosmetic procedure?

Cosmetic
procedures like Botox injections, fillers and face-lifts are
aesthetic investments patients contemplate well in advance of
stepping into a doctorís office. But they often require more
than a one-time visit, so itís important to know how long a
procedure is expected to last and what the signs are that itís
time to refresh or renew it.

Age,
severity of problem areas and genetics all factor in to figuring
out that time table. Yet, there are some general rules of thumb.

Dr. Alex
P. Colque at Skiin Anti-Aging Lounge in Waukesha says Botox
injections typically need to be redone every few months, while
hyaluronic acid-based fillers such as Juvederm last nine months
to a year. Thicker fillers, made from calcium hydroxylapatite,
can last up to 18 months. "Botox has been out for 10
years," Colque explains. "There are certain techniques
that we use to make it work better and more effective, but the
medication is still the same."

He and
other experts say itís best to be proactive rather than
reactive. Although a small percentage of patients return before
needing their next treatment, many wait until wrinkles reappear
or lifts begin to fade. But waiting can exacerbate the issue.
"If they donít keep up (regular treatments), itís more
difficult to make wrinkles disappear," he insists.

Plastic
and reconstructive surgeon Mark F. Blake of the Clinic of
Cosmetic Surgery in Milwaukee says education is key. He advises
patients to do their homework.

"Concentrate
on the issue youíre trying to address, and make sure that the
treatment is doing what you need," says Blake, who is also
medical director of LíImage Skin Spas.

For
instance, there are various face-lift treatments, including mini
lifts and skin-only face-lifts, that Blake says do not always
live up to their claims. Itís the muscle-tightening face-lift,
he says, that is most widely used by plastic surgeons and that
has the most effective result over a longer period of time.

Plus, he
says other considerations impact efficacy: Is the patient over
50? Was there sun damage, severe sagging or deep creases before?
Blake says such factors can contribute to how far a treatment
can "set back the clock."

"People
really need to be educated," he adds. "Go somewhere
where they have all of the tools, so that youíll have all of
the options available. Thatís the most important thing."

- Lisa
Jones Townsel

Aesthetic
nurse specialists now sanctioned

The
expanding field of aesthetic nursing now has its own nationally
recognized exam and certification. Not to be confused with
plastic surgery certification, the aesthetic nurse specialty
focuses on the use of cosmetic treatments such as dermal fillers
like Botox, chemical peels, microdermabrasion and laser
treatments, rather than surgery.

Locally,
Dawn Sagrillo of ReFresh Aesthetic Center in Whitefish Bay was
instrumental in the development of the first and only national
exam and certification for aesthetic nurse specialists. Sagrillo,
the clinical director and aesthetic nurse specialist at ReFresh,
worked on creating the exam for five years, along with three of
her colleagues. "We worked collaboratively with the
American Society of Plastic Surgeons to obtain their support and
approval. We wanted to include any nonsurgical cosmetic
treatment as well as the psycho-social aspects of the
treatments," she explains.

What does
this mean to potential patients? "Patients benefit because
this is a growing specialty with many providers offering
injectables and various other treatments, and it can be
confusing. We felt that certification tells the public that
these nurses have met certain core competencies that create a
standard of care that ensures safety to the patient,"
Sagrillo says.

Not just
anyone can take the CANS exam, which is another way to
demonstrate the dedication of those nurses who earn the
certification. "Nurses have to meet the criteria. They have
to be in the field for two years before they are eligible to
take the exam. They must spend 50 percent of their time doing
this work, and they must maintain it to keep the
certification," Sagrillo says. "Itís an exciting
time for this specialty."

For more
information about where the CANS exam can be taken, go to
PSNCB.org